The scale of unmet care needs
The public debate about social care provision tends to focus on eligibility for local authority funded care and support services, both in terms of the needs based eligibility criteria and the thresholds for means tested support. However, formal local authority provided care represents only a fraction of the care and support received by older people. The solutions to meeting the care needs of our growing older population need to be found beyond local authority provision of social care and support services.
Our recent research looking at unmet need for care among older people living in their own homes, carried out in collaboration with NatCen Social Research, Independent Age and Age UK has shed light on where some of those solutions might lie. We found that unmet need is widespread but often hidden. It affects people from all walks of life and with varying levels of financial resource and yet surveys underestimate aspects of unmet need such as those relating to social contact. Furthermore older people can be reluctant to discuss unmet need for help with basic aspects of day to day living. Needs go unmet for a variety of reasons including pride in being independent and not becoming a burden, feeling too young to use care services, difficulty planning for care and accessing services and concerns about the costs of care. Those who live alone, have lost a partner or who have developed care needs more recently seem more vulnerable to unmet need.
While resilience and a determination to retain independence are positive and in line with current policy on prevention and the use of adaptations, our research found that this also hid situations in which older people appeared to be coping but at the cost of pain, exhaustion and having no time for anything else. In some cases an adaptation was not sufficient and support was needed to use it. Furthermore, current arrangements were often precarious, either day-to day or because the person was reliant on a very limited support network, perhaps from a spouse with their own health problems.
The challenges associated with daily living and difficulties in getting out and about were linked to loneliness and social isolation and being cut off from previous activities which were enjoyed or brought fulfilment. This impacted on older people’s well-being widely, and in some cases was associated with poor mental health. However, we also found that access to longstanding community ties, continued participation in hobbies, the ability to go out by public transport or care and being able to contribute to their families or communities could mitigate the impacts of unmet need on well-being. A sense of independence and purpose among those who were managing without support or with limited support also appeared to have a beneficial impact on well-being and quality of life.
So what can we conclude and where do the solutions lie?
Older people vary in their resilience, desire for independence, networks of support, involvement in wider activities, confidence and ability to seek out and access services. The same adaptation or source of support which may help support independence for one person, may be insufficient for another who will be left with an unmet need. A third person may feel the same support would take away their independence. Similarly, the ‘signposting’ to phone lines or internet support may be all one person needs to find a solution to their needs, while for another person who lacks the confidence to make calls and explain their needs, or for someone who wants detailed information about financial planning for future care needs, this may be insufficient. The particular experience, preference and desired outcomes for the individual need to be considered by charities, local authorities and providers when providing information and services. One size does not fit all, and while financial constraints may lead to standardised offers, more tailored, person centred approaches may be a better use of scarce resources, particularly where this supports many older people’s desire to maintain independence.
Individuals also have a responsibility to plan for their older age and future care needs. So far the messages have focussed on the need for financial planning, something which is hard to do since the extent of one’s future needs is unknown. However, individuals can also prepare for future or changing care needs or mitigate the impacts of unmet needs, through maintaining and extending their social networks, being involved in wider activities and their communities and building resilience to setbacks and challenges. This is not necessarily easy but in a context of an increasing pressure on services, may need to be part of the solution.
The needs of older people and their carers can be met by public and private services well beyond traditional care and support services and adaptations. Access to education courses, sports and social clubs and gyms, affordable public transport, adapted private transport and suitable housing can assist people in meeting their care needs, retaining independence and maintaining well-being. Policy makers should look to the needs of older people in relation to housing design, transport policy and funding to local authorities, where the protection of social care budgets has led to even deeper cuts to other services such as buses, libraries and community groups and facilities. Policy makers and local authorities can also play a role in encouraging action in the wider community and private sector, through policies and incentives.
The research referred to here was carried out by Ipsos MORI and NatCen Social Research in collaboration with Age UK and Independent Age. The research is independent research funded by the National Institute for Health Research School for Social Care Research (NIHR SSCR) (Grant: C088/T14-035/IMMB-P66).
The views expressed here are those of the researchers involved and not necessarily those of the NHS, the NIHR or the Department of Health. Nor are they necessarily the views of Independent Age or Age UK.